This document describes the anatomy and x-ray imaging of the paranasal sinuses and orbit. It details the four groups of paranasal sinuses - frontal, maxillary, ethmoidal, and sphenoidal. It explains their functions and anatomical features. Maxillary sinus anatomy and relations are described in detail. Common sinus infection sites in children involve the ethmoidal sinuses. X-ray views for examining the paranasal sinuses include Waters, Caldwell, and lateral views. Orbital anatomy includes bones forming the roof, floor, medial and lateral walls, and fissures like the superior and inferior orbital fissures.
Detailed discussion on tumors and other pathologies of paranasal sinus and their management. Surgical anatomy and approaches are also discussed. Complications of PNS surgeries are discussed briefly
Detailed discussion on tumors and other pathologies of paranasal sinus and their management. Surgical anatomy and approaches are also discussed. Complications of PNS surgeries are discussed briefly
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
3. • Para nasal sinuses are air filled sacs
found in the skull bones
• Situated around the nasal cavity.
• Lined by mucus secreting
epithelium.
• Four groups -
Frontal sinuses
Maxillary sinuses
Ethmoidal sinuses
Sphenoid sinuses
4. Function of Paranasal Sinuses
• The presence of these sinuses lightens the skull
• They add resonance to speech
• They play a vital role in conditioning the inspired air (Warm &
moisten air)
5. Maxillary sinus /Antrum of Highmore
• Largest of all paranasal sinuses
• Pyramidal in shape with Apex directed
laterally
• The maxillary sinuses are the first to
appear and are visible radiologically from
4-5 months after birth.
• Anterior wall – facial surface of maxilla
• Posteriorly – infratemporal and
pterygopalatine fossa
6. Roof – floor of the orbit.
Floor – alveolar process of maxilla
and the hard palate
7. Frontal sinus
• Located within the frontal bone adjacent to the
fronto-nasal articulation
• Vary in size ; may be asymmetrical
• Drains into middle meatus via the frontal recess
8. Ethmoidal sinus
• These consist of a labyrinth of bony
cavities or cells situated between the
medial walls of the orbit and the lateral
walls of the upper nasal cavity.
Three groups:
• Anterior & middle :Drains into middle
meatus
• Posterior :Drain into superior meatus
9. • Lateral wall – Is formed by the orbital plate of ethmoid. It is paper
thin and is known as lamina papyracea. Infections involving the
Ethmoidal air cells may spread to the orbit via this thin plate of bone.
• Roof – lies the frontal bone anteriorly, by the sphenoid posteriorly.
• Common sinus infections in children involve Ethmoidal sinuses
10. Sphenoid sinus
• within the body of the sphenoid
• drain into spheno-ethmoidal Recess.
Relations:
• above to the sella turcica,
•laterally, to the cranial cavity, particularly
to the cavernous sinuses
• below and in front, to the nasal cavities.
11.
12. X ray Paranasal sinuses
• The indication and the need for plain X-rays in diagnosis and further
management sinus pathology has declined over the last decade.
• CT is the imaging modality of choice.
• There is still a role for plain films of the paranasal sinuses in acute
infection.
• Advantages of x-ray imaging for PNS include:
1. Cost effectiveness
2. Easy availability
14. Waters View
• Also known as occipito mental view
• is the commonest view taken for paranasal sinuses
• developed by Waters and Waldron in 1915
• This was actually a modification of occipito frontal projection
(Caldwell view)
15. • Positioning of patient :
• The patient is made to sit facing the bucky.
• Head is adjusted to bring orbito meatal line to
45 deg to the cassette
• The patient’s nose and chin are placed in
contact with the midline of cassette.
• Median Sagittal Plane perp to bucky
16. • Horizontal central line of cassette should be at the
level of the lower orbital margins
Centering –
• Central ray perpendicular to the cassette
• Centred 1 inch above the external occipital
protuberance.
17. Essential image
characteristics
• Petrous ridges projected
immediately below
maxillary sinuses
• Ensure no rotation :
Distance from lateral
border of skull and orbit
equal on each side
18. Opacification due to acute maxillary sinusitis and fluid levels seen on tilted view.
19. Caldwell view [occipito frontal with 15 deg caudad]
• This projection is used to demonstrate the frontal
and ethmoid sinuses.
• Positioning of patient :
• Patient is seated facing the erect bucky
• Neck is flexed to bring nose and forehead in contact
with the bucky.
• orbito meatal line perpendicular to the bucky,
20. • Central ray :
• Ray is directed perpendicular to the bucky along
the median sagittal plane.
• The tube is rotated 15 deg caudal to the orbito
meatal baseline
• centered 1/2 inch below the external occipital
protruberance
21.
22. Lateral view
• Patient sits facing the cassette
• Head is then rotated, such that the
median sagittal plane is parallel and
the inter-orbital line is perpendicular
to cassette.
• Head is adjusted so that the centre
of the cassette is along the orbito-
meatal line.
23. • Centering -
• centred to a point 1 inch posterior
to the outer canthus of the eye.
• X ray beam is perpendicular to the
cassette.
24. Essential image
characteristics
•A true lateral will have
been achieved if the lateral
portions of the floors of the
anterior cranial fossa are
superimposed
26. • Pyramidal bony cavity => base lies anteriorly ; apex posteriorly.
• 4 walls: a roof, floor, medial and lateral wall, all of which converge
posteriorly at the orbital apex
27. Roof
• thin, separates the orbit from the
anterior cranial fossa.
• Frontal bone anteriorly
• Lesser wing of sphenoid
posteriorly.
The orbital roof forms the floor of
the frontal sinus
28. Floor
• Zygomatic bone laterally
• Maxilla medially,
• with a small contribution from
the orbital process of the
palatine bone;
The orbital floor forms the roof
of the maxillary sinus and is
relatively thin, thus susceptible
to blow-out fracture.
29. Medial Wall
1. Maxilla
2. Ethmoid
3. Lacrimal
4. Small contribution from Sphenoid
It is a very thin wall, separates the
orbit from the nasal cavity.
31. Fissures
• Superior orbital fissure is a
triangular slit between the greater and
lesser wings of sphenoid.
• Runs upwards and laterally.
• Transmits
Lacrimal, Frontal, and Nasociliary
branches of the ophthalmic nerve
(V1), III , IV and VI cranial nerves,
Superior ophthalmic vein and
Br of Middle meningeal artery.
32. Inferior orbital fissure
• lies between the lateral wall and
floor of the orbit as they converge
on the apex of orbit.
• Runs downwards and laterally .
• Transmits the maxillary nerve (V2)
and its zygomatic branch, the infra-
orbital vessels.
33. • Optic Canal - round opening at
the apex which opens into the
middle cranial fossa
• Bounded medially by the body
of the sphenoid and laterally by
the lesser wing of the
sphenoid.
• Transmits
optic nerve
ophthalmic artery
34. • The infraorbital groove runs from the
inferior orbital fissure in the floor of the
orbit before dipping down to become the
infraorbital canal.
• Infra-orbital nerve, part of the maxillary
nerve V2 ,and vessels pass through this
structure as they exit onto the face.
35. Occipito-mental (modified)
• Positioning-
• Best performed with the patient seated
facing the cassette
• Patient’s nose and chin : midline of the
cassette
• Horizontal central line of cassette : level
of the midpoint of the orbits
36. • Centering :
• Central ray of the skull unit should be perpendicular to the cassette
• Centred 1 inch above the external occipital protuberance
• There should be no rotation. This can be checked by ensuring that
the distance from the lateral orbital wall to the outer skull margins
is equidistant on both sides.